World Physiotherapy response to COVID-19 · World Physiotherapy is producing a series of papers in...
Transcript of World Physiotherapy response to COVID-19 · World Physiotherapy is producing a series of papers in...
IMMEDIATE IMPACT ON THE HIGHER EDUCATION SECTOR AND RESPONSE TO DELIVERING
PHYSIOTHERAPIST ENTRY LEVEL EDUCATION
May 2020
World Physiotherapy response to COVID-19
Briefing paper 1
THIS PAPER HAS BEEN PRODUCED IN COLLABORATION WITH
World Physiotherapy briefing papersWorld Physiotherapy briefing papers inform our member organisations and other stakeholders about key issues that affect the physical therapy profession.
World Physiotherapy is producing a series of papers in response to COVID-19.
The first briefing paper presents the initial results of the survey of physiotherapist education programmes on the early experiences and consequences of COVID-19 on entry level physiotherapist education.
AcknowledgementIn April 2020, in response to the COVID-19 pandemic, World Physiotherapy launched a global task force on physiotherapist education. The purpose of the task force is to gather key stakeholders and actors in physiotherapy entry to practice education from the global community. It brings together individuals from across World Physiotherapy’s regions, from education, regulation and accrediting organisations collaborating to:
establish the impact and consequences of COVID-19 in the short term on physiotherapist entry to practice education
map and share best educational practice and resources in responding to the current crisis
consider collective responses to the consequences for physiotherapist entry-to-practice education in the short and medium term
consider the longer term forecast horizon and issues that may need to be addressed
consider questions and opportunities for collaborative scholarship and thought leadership
Task force members: Patricia Almeida, Tracy Bury, Jean Damascene Gasherebuka, Karim Martina Alvis Gomez, Djenana Jalovcic, Suh-Fang Jeng, Rachael Lowe, Katya Masnyk, Nina Rydland Olsen, Barbara Sanders and Emma K Stokes
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Key Messages
Three hundred and three (n=303) physiotherapist education programmes from 58 countries
participated in a survey on the early experiences and consequences of COVID-19 on entry level
physiotherapist education. Their responses provided insights into how the programmes resolved the
immediate challenges, how they addressed near-term issues and what, at this time, they anticipate as
barriers to return to post-pandemic operations.
Ninety-three percent (93%) of respondents reported that
they expected challenges in entry level education and
assessment due to the COVID-19 outbreak.
Most of the respondents noted that clinical or practice
education, as well as practical skills, and clinical practice
performance assessment were major challenges.
The majority of respondents reported that they moved online
for theoretical classes, clinical reasoning and critical thinking
development, and practical skills, as well as assessments,
except for practical skills for which 50% of respondents
postponed the assessment.
For the practice education of students in non-graduating
years
o 40% of respondents had already offered to postpone it
o 30% proposed to substitute it with tele-rehabilitation or
telehealth
o 36% considered non-clinical practice
o 31% considered simulations
o 26% reported reducing the needed number of hours
The graduating year students experienced greater impact:
o over one third of students face a delay in graduation
o one third had another substitute learning experience
introduced
o one quarter had decreased the number of hours
needed for practical education
After the end of outbreak, respondents anticipated that the
main challenges will be organisation of clinical practice and
the need to adjust the curriculum for the next academic
year.
Major lessons learned are around the potential and
limitations of online learning, communication and flexibility.
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Introduction
Because of the nature of the COVID-19 pandemic, epicentres have moved across the world and the
impact has varied as a result of preparedness, resilience and timing, hence forecasting horizons are
uncertain. An adapted version of a McKinsey and Company (2020)1 model describing five stages of
the global health crisis response framework was used in this paper to inform our timelines for the
purposes of the work of the Education Task Force (Box 1). We substituted ‘reshape’ for ‘reform’
reflecting the opportunities as well as the challenges that will arise from this unprecedented crisis.
Box 1: Five horizons
Resolve
How were the
immediate
challenges
addressed?
Resilience
How were the
near-term
challenges
addressed? What
are the best
practices? How
was resilience
promoted?
Return
What does return
look like? What is
the plan for return
back to scale?
What are the
immediate knock-
on effects and
what comes
later? What
lessons have we
learned?
Reimaging
What does the
future entry level
education look
like? What
changes are
necessary to
meet the needs
of society? What
are the
implications for
education?
Reshape
What changes
will occur, or be
driven, in health,
education and
practice?
Purpose
The purpose of this paper is to highlight the immediate consequences of COVID-19 on physiotherapy
entry level education programmes across the world, with a view to establishing an understanding of
actions taken, and issues arising, that may require further consideration in terms of action and
advocacy. In addition, it serves as a preliminary global benchmark for education programmes to
reference in describing or justifying their actions. Moreover, for those who have yet to manage the
issues or respond to the challenges, it may provide some examples of best practice at this time.
Context
World Physiotherapy is made up of 121 member organisations from five regions and from low, middle,
and high resource countries. Hence, there is great diversity in the education experiences in the
countries/territories of its member organisations.
Globally there are a variety of contexts in which education takes place, as well as a diversity of health
care delivery systems in which physiotherapy is practised. Moreover, the trajectory and impact over
time of COVID-19 means that as the epicentre moves, societies and communities will be affected in
different ways.
The following contexts may influence entry level education, either directly or indirectly in the resolve
phase, as well as in later phases: 1 McKinsey & Company (2020) COVID-19: Briefing materials. Global health and crisis response. Updated: March
25 2020.
https://www.mckinsey.com/~/media/mckinsey/business%20functions/risk/our%20insights/covid%2019%20implica
tions%20for%20business/covid%2019%20march%2025/covid-19-facts-and-insights-march-25-v3.ashx
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Political: the nature of political systems –
centralised or devolved decision-making
systems, state or federal systems; the extent
to which decisions are made by politicians or
health experts and how public health
restrictions are mandated and enacted all
impact on higher education at this time.
Economic: in addition to the wider global
economic consequences of COVID-19, funding
models of education programmes and higher
education institutions will be tested. The
impact of loss of physiotherapy practices,
which are a source of clinical education as well
as employment, faculty retention and
recruitment, may all be impacted depending on
the economic impact of COVID-19.
Social: the resilience of the social contract in
communities and societies and the social
impact of public health restrictions will all
inform the consequences for education and
practice.
Technological: teaching and learning
platforms have been rapidly utilised as
educational programmes transition online.
Consideration must be given to the digital
divide, as some have access to the latest
technology and others do not. How technology
can be optimised for education, practice and
licensure depend on context.
Legal: various legal frameworks at national
and/or provincial or state level, will inform
regulatory agility, as well as practice, which in
turn affects entry level education.
Environmental: a fundamental question is
what return to education will look like in terms
of public health restrictions. In addition, there
are wider questions about transport, travel,
social contact, practice education locations
etc., all of which impact on the delivery of
physiotherapist education.
Covid-19 has disrupted our approach to social interaction, the way to do business and the way we
provide services the world over. In doing so, it has challenged us to re-think almost everything that we
do and has provided a unique opportunity for the profession of physiotherapy to come together and
work through challenges that we are all facing, regardless of country or home organisation.
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What did we know at the formation of the task force?
Anecdotally, we knew that entry level education programmes for physiotherapists had to transition
online rapidly and with little or no preparation. The impact has been felt everywhere, but with
significant variation. Transitions appear to have had most significant impact on students close to
completion of their degree; some may have delays in graduation and others may be fast-tracked into
the workforce, and the regulatory response has been varied.
With a view to ascertaining the initial response and the development of resilience in the global
physiotherapist education community, a survey was developed collaboratively by the American
Council of Academic Physical Therapy (ACAPT), Centro Latinoamericano para el Desarrollo de la
Fisioterapia/Kinesiologia (CLADEFK), European Network of Physiotherapy in Higher Education
(ENPHE) and World Physiotherapy to gather information on the early experiences and consequences
on of COVID-19 on entry level physiotherapist education.
Global survey 1: Immediate challenges and responses
ENPHE and CLADEFK prepared a first version of the survey, which was then developed
collaboratively with the inclusion of World Physiotherapy and ACAPT. The final version, in English and
Spanish, was circulated through established formal and informal networks and remained open until 29
April 2020. French and Portuguese translations were also developed, and further responses will be
added to the initial data review over time.
To date, 303 programmes from 58 countries have responded to the English and Spanish language
versions of the survey, with 19% of respondents identifying as members of ENPHE, 21% from ACAPT
and 9.5% as members of CLADEFK. The most common programme degree qualification is Bachelor’s
degree (76%), with Master’s degree reported by 11.5% and Doctoral degree by 24%.
Resolve: Challenges in the immediate phase of response
to COVID-19
Ninety-three percent (93%) of respondents reported that they expected challenges in entry level
education and assessment due to the COVID-19 outbreak.
Delivery of education The top five challenges reported were:
scheduling and/ or teaching practical classes (86%)
managing/delivering clinical education/ practice education (74%)
planning future clinical education/ practice education (66%)
scheduling and/ or teaching community-based sessions which are part of programme courses
(54%)
students coping strategies with the situation (44%)
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Most of the respondents noted that clinical or practice education was not possible and postponed.
Issues related to safety, and the challenges and uncertainty of re-scheduling, were also reported, as
well as meeting the requirements of accreditation bodies.
Over half of respondents (52%) reported that entry level degree graduation assignments (thesis,
final projects, research project or others) were unable to commence, or students were unable to
complete data gathering.
Assessment and evaluation The top two challenges facing respondents were difficulty implementing practical skills assessment
(80%) and clinical practice/practice education performance assessment (71%).
Further difficulties were reported regarding:
assessing current competence level (51%)
assessing competence development (46%)
difficulty ensuring the integrity of the assessment process (47%)
Seventy-one percent of respondents reported that practice education assessments could not take
place on clinical sites, with 72% noting that students had been unable to complete placements.
Of note is that:
21% of respondents noted no challenges in the assessment of graduation assignment for
example thesis, final projects, research project or others
35% noted that students had been unable to complete the assignment
37% reported that student presentations and/or vivas could not take place due to public health
restrictions
Resilience
Delivery
Programmes have responded in various ways to managing delivery of education. Table 1 illustrates
the most common alternatives offered for various teaching and learning experiences.
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Table 1 Alternative teaching and learning experiences offered
Theoretical
classes
Developing
clinical
reasoning
and critical
thinking
Practical
skills
Online sessions created by programme
academic staff 88.7% 18% 53%
Online sessions using existing material
available online 58.6% 53% 50%
Promoting self-study 31% 38.4% 25%
Offer an alternative learning experience 28% 30% 30%
Postponement 14% 18% 30%
Removal from cohort’s study plan 2% 2.5% 2%
When asked about alternatives for clinical or practice education higher educational institutions (HEI)
were offering to students in the non-graduating years, 40% of respondents reported that they
considered, or already offered, to postpone practice education until the next academic term, semester
or year. Thirty-three per cent (33%) proposed to substitute face to face practice experience with tele-
rehabilitation or telehealth. Thirty-six percent (36%) reported that they considered another non-clinical
practice learning experience that allows the student to achieve the learning outcomes. Replacing
practice education with simulation contexts (31%) and decreasing the number of hours needed for
practical education (26%) were other common responses reported.
For the graduating year’s students, 36% face a delay in graduation to allow an internship after the
crisis passes. Thirty-four percent (34%) have substituted another learning experience not in clinical
practice to achieve the learning outcomes, with 24% decreasing the number of hours needed for
practical education.
Other responses for the graduating class of 2020 were:
substitute face to face practice experience with tele-rehabilitation or telehealth (24%)
another alternative or learning experience (22%)
use of simulation contexts (19%).
Only 9% will consider establishing a probation period.
Solutions to challenges faced with assignments, such as theses, research projects and dissertations
for the graduating year are varied. Interestingly, 18% of respondents noted there was no need for an
alternative, and 17% noted this question was not applicable to them. However, for those to whom this
applied, 19% also noted that graduation would be delayed to allow for the completion of the
assignment. The use of theoretical data or expected results (29%), or secondary data (25%), were
common solutions with substitution with another alternative learning experience also being noted
(18%).
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Assessment
The alternatives that respondents were considering or already offering in managing the assessment
and evaluation of various components of the degree are listed in Table 2.
Table 2 Alternative assessment and evaluation strategies
Theoretical
examinations
Assessing
clinical
reasoning and
critical thinking
Community
learning
assessment*
Practical
exams
Online theoretical
assessment 64% * * *
Online alternative
assessment - individual
assignment
42% 48% 28% 33%
Online alternative
assessment - oral exam 31% 34% 16% 36%
Online alternative
assessment - open
book exam
26% * * *
Online alternative
assessment – group
assignment
20% 25% 16% 12%
Postpone 18% 20% 34% 49%
Programmatic
assessment – valuing
development and
formative feedback
22% 29% 21% 19%
Strategies focused in
competences instead of
course/discipline
learning outcomes
16% 28% 18% 17%
*Not offered as answer
For clinical or practice education assessments, respondents were asked to provide information of
arrangements for the graduating class as well as other years. Table 3 lists the responses.
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Table 3 Alternative clinical education assessment approaches
Graduating year Other years
Not applicable 12% 8%
No need for alternatives 14% 5%
Graduation delay to allow for internship or
postpone assessment (non-graduation class) 35% 46%
Programmatic assessment – valuing
development and formative feedback 29% 21%
Strategies focused in competences instead of
course/discipline learning outcomes 27% 23%
Online alternative assessment – individual
assignment * 25%
Online alternative assessment – oral examination * 19%
*Not offered as answer
Student perspective In parallel to the survey gathering experiences from HEIs there has been a survey to understand the
situation from the perspective of students. This will be explored in a later paper. A preliminary analysis
of the data from 1819 students from 39 countries shows that the challenges experienced by HEIs
resonate with those of students.
Box 2: Student experiences
clinical education postponed or cancelled with contingency plans unclear leading to worry
and uncertainty
some graduations postponed
changes for final graduation projects have not been communicated yet
online education is widely offered
email combined with other online platforms are the preferred communication methods
coping with uncertainty is a challenge in itself
Return
Institutions were asked about the challenges they anticipated for entry level physiotherapy
education after the outbreak period. Challenges reported are listed below in order of frequency
reported:
clinical practice restrictions (76%)
need to adjust curriculum for next academic year (65%)
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admission issues (47%)
student drop-outs due to financial issues (46%)
educational staff overload (46%)
need to adjust the academic calendar for the next academic year (45%)
student drop-outs due to low academic success (22%)
Reimagine and reshape
Although the primary intention of the survey was to
illuminate the first three horizons of the crisis
response, resolve, resilience and return, it has also
captured lessons learned, benefits and innovative
practices. These can be used to inform the next
stages - reimagine and reshape.
The main learning outcomes are to be flexible and
creative and to recognise the importance of
communication:
learning over teaching
not everything can be converted online (issues with practical and clinical content)
e-learning has been underestimated education should resort more to it digital education
can also be used in the future
assessment reformulation
Benefits and innovation
The main benefits for entry level physiotherapy education are the emergent digital transformation,
where online learning (can be used as an alternative resource to the traditional classroom more
than expected) and students learn to be more self-directed and autonomous in their learning:
opportunity for programmes to also develop and test online content for their programmes
alternative strategies for learning, assessing and communicating
telehealth opportunities
become more efficient in teaching “what’s necessary” versus “what’s nice to know”
administrative improvement (operations transferred to digital formats)
Support
Seventy percent (73%) state their institutions need support for:
online assessment alternatives (73%)
online education materials (60%)
online forum sessions (27%)
digital skills of faculty (13%)
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students’ digital skills (18%)
In addition, 58% state they and their institutions would be available to support others. Most
respondents reported that they would be able to share their experience on how they dealt with the
situation, potentially assisting others, who are clearly in the same situation. For example:
some could offer tips and alternative assessment methods
provide basic support on technology and online learning platforms
share online education materials
consultation
Version 1.0 04 May 2020
© World Physiotherapy